Provider Demographics
NPI:1922548692
Name:JOHNSON, RONDA LEE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:RONDA
Middle Name:LEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23580 220TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-9428
Mailing Address - Country:US
Mailing Address - Phone:817-975-1949
Mailing Address - Fax:817-887-2899
Practice Address - Street 1:23580 220TH ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-9428
Practice Address - Country:US
Practice Address - Phone:817-975-1949
Practice Address - Fax:817-887-2899
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA058311363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily